TY - JOUR
T1 - Respiratory insufficiency in newborns with abdominal wall defects
AU - Hershenson, Marc B.
AU - Brouillette, Robert T.
AU - Klemka, Linda
AU - Raffensperger, John D.
AU - Poznanski, Andrew K.
AU - Hunt, Carl E.
N1 - Funding Information:
From the Departments of Pediatrics, Radiology, and Surgery Northwestern University, Chicago. Supported in part by a grant from the Children's Research Guild. Presented in part at the Annual Meeting of the Midwest Society for Pediatric Research, Chicago, November 2-4, 1983; and at the 33rd Annual Meeting of the Surgical Section of the American Academy of Pediatrics, Chicago; September 15-16, 1984. Address reprint requests to Robert T. Brouillette, MD, Division of Neonatology, Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL 60614. 9 1985 by Grune & Stratton, Inc. 0022-3468/85/2004~)011 $03.00/0
PY - 1985/8
Y1 - 1985/8
N2 - Respiratory failure in newborns with abdominal wall defects has been attributed to increased intra-abdominal pressure and elevation of the diaphragm after closure. Despite surgical techniques designed to minimize intraabdominal pressure, we have obseved prolonged respiratory insufficiency in several such infants. We reviewed the charts of 108 infants from 1975 to 1982 who had abdominal wall defects: 53 with gastroschisis, 29 with small omphaloceles, 22 with liver-containing or giant omphaloceles (GO), and four with cloacal exstrophy. Nine infants with GO (41%) had prolonged respiratory insufficiency and five died. Infants with GO required longer periods of oxygenation and ventilation (P<.001, ANOVA) than infants with other abdominal wall defects. Clinical observation suggested that infants with GO have a small, narrow thorax. We obtained detailed measurements from the chest radiographs of infants in all groups. After correction for birth weight, babies with GO had smaller chest widths (P<.001) and lung areas (P<.05) than infants with other abdominal wall defects. At autopsy, one newborn with GO was found to have severe pulmonary hypoplasia. Prolonged respiratory insufficiency in infants with GO may be explained by pulmonary hypoplasia and/or by a narrow chest deformity which limits lung expansion.
AB - Respiratory failure in newborns with abdominal wall defects has been attributed to increased intra-abdominal pressure and elevation of the diaphragm after closure. Despite surgical techniques designed to minimize intraabdominal pressure, we have obseved prolonged respiratory insufficiency in several such infants. We reviewed the charts of 108 infants from 1975 to 1982 who had abdominal wall defects: 53 with gastroschisis, 29 with small omphaloceles, 22 with liver-containing or giant omphaloceles (GO), and four with cloacal exstrophy. Nine infants with GO (41%) had prolonged respiratory insufficiency and five died. Infants with GO required longer periods of oxygenation and ventilation (P<.001, ANOVA) than infants with other abdominal wall defects. Clinical observation suggested that infants with GO have a small, narrow thorax. We obtained detailed measurements from the chest radiographs of infants in all groups. After correction for birth weight, babies with GO had smaller chest widths (P<.001) and lung areas (P<.05) than infants with other abdominal wall defects. At autopsy, one newborn with GO was found to have severe pulmonary hypoplasia. Prolonged respiratory insufficiency in infants with GO may be explained by pulmonary hypoplasia and/or by a narrow chest deformity which limits lung expansion.
KW - Omphalocele
KW - abdominal wall defect
KW - gastroschisis
KW - respiratory failure
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U2 - 10.1016/S0022-3468(85)80217-7
DO - 10.1016/S0022-3468(85)80217-7
M3 - Article
C2 - 2931509
AN - SCOPUS:0021990238
VL - 20
SP - 348
EP - 353
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
SN - 0022-3468
IS - 4
ER -